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June, 2010: Spina Bifida, Depression and the Will to Work

Today's blog involves the case of Janice, who had been working for many years as a preschool teacher's assistant until such time as her longstanding (congenital) difficulties from Spina Bifida and corresponding depression caused her to leave work. While Janice was able to struggle through work for a number of years while taking narcotics, an exacerbation of her condition caused her to discontinue working entirely.

Janice filed her initial claim out of the Portsmouth, New Hampshire Social Security District Office, given she lives in Southern Maine in York County.  Upon being denied on reconsideration, she filed a request for hearing and her case was assigned to the Portland, Maine Office of Disability Adjudication and Review. 

As part of our role in the representation, we worked with Janice to obtain physical residual functional capacity assessments from her primary care physicians and a mental impairment questionnaire that was addressed by her counselor (and signed onto by her primary care physician, to ensure that this document was given controlling weight as coming from what is deemed a treating source: a counselor's report would not receive such weight from the Social Security Administration).  In most cases, we would recommend that our clients remain in treatment with specialists for any condition they believe is severe.  In Janice’s circumstance, she was dealing with a physical condition that she has had since birth and which would be expected to progressively worsen as she ages.  There would not have been much that a back specialist could do for her, as was made clear by an examination set up for her with an orthopedic specialist.  With respect to mental health conditions deemed to be severe, we would ordinarily suggest that one remain in treatment with both a counselor and a psychiatrist as these are what would be considered specialists with respect to mental health.  Unfortunately, Janice’s insurance made it very difficult for her to see a psychiatrist, and she did have the benefit of a longstanding relationship with a very well respected counselor that has treated and had documented well Janice’s decline over a period of years.

At the hearing level, months prior to  the scheduled hearing, we undertook a legal brief (what we refer to as an On the Record request) as we had great support from her treating physicians that now spelled out how disabled she remained as a result of her conditions.  The brief served to convince the Administrative Law Judge (ALJ) as to the severity of Janice’s conditions and caused them to cancel the scheduled hearing as they felt able to now provide Janice with a fully favorable on the record decision. As can be seen from my prior blogs, many times favorable decisions (without the need for a hearing) can be obtained if one's treating physicians are willing to go to bat for you and address the extent of one's limitations (both physical and mental).

I was happy to see that Janice's treatment providers understood how she had struggled and continued to struggle for so long with her conditions and it had simply gotten to the point where she could not battle through the pain and the limitations that were weighing on her emotionally as well. Janice's loss of income had placed quite a strain on her family and I am thrilled to see that this has been remedied by providing her with substantial retroactive benefits.